Figuring Out The Way Forward After Injury

A bit back, I injured my knee rather seriously while playing Ultimate. We were in Bangalore, playing a tournament, and it was the last point of the last game, and I was tired, ended up landing rather hard and tried to turn while my ankle was still planted, and heard a pop in my knee, followed by pain. It has been a hard time, and am while am still not done with my recovery, I've learned quite a bit from this episode and wanted to write about it. This is not about what to do if you injure your ACL etc, but rather about how surprisingly difficult and confusing this entire process was. While I am not an expert on injuries and physiotherapy, I am reasonably clued in about it. And yet, there were a lot of doubts and roadblocks that I went through.

Right after the injury

I was in no position to go anywhere. So, I was moved out of the way to the sideline, until the game and the spirit circle finished. After that, I managed to hobble along with lots of help, and we went directly to the best ortho (Doc 1) around nearby. My knee was pretty swollen, as is normal in this scenario. After getting an x-ray done to see if there was a fracture, the ortho swung by and did a few standard tests to see if my ligaments held. He seemed pretty satisfied, told me that my bones were contused (bruised) from the fall and that I needed to rest. No torn ligaments or anything like that - which was my initial fear. ### My research

While I was resting, I did my research on knee injuries, trauma, bone bruising, and ACL tears as well. Just some background on the anterior cruciate ligament (ACL). A ligament is tissue that connects two bones, and the ACL is one of four ligaments that connect the thigh to the shin (femur to tibia). The knee joint's main function is stability, rather than mobility. It is not built for rotation or for too much forward movement. So, when my ankle got stuck and I still tried to pivot, rotation is exactly what my knee did. Everything that happened to me was indicative of ACL and meniscal tears. So, I wanted to be careful. My goal out of this was pretty straightforward - I wanted to get back to doing whatever I normally do - train and play Ultimate. Normally, I rush things. I figure out what the best thing to do is, and do it. But I was not going to rush it, but be patient, listen to the experts (rather than lead with my research) and do what was required. If only it was that straightforward! Most of my research indicated that I would need surgery if I had torn a ligament. I was young enough, and my activities required it as well. But one resounding thing was to get the knee as good as possible, before surgery. This would improve chances of the knee getting healthier, and back near its best. And this was what I used as a guiding tool, throughout this process. ### More Rest?!

I was told that if I did any kind of physio work, I would be delaying the healing process. My knee would function normally once the bruising went away. And rest was the best thing. Once I got back to Madras, I wanted to seek another opinion, and went to an ortho (Doc 2). I was advised more rest and told to come back with an MRI. He said that the bruising had not subsided yet, and hinted at ligament damage as well. I went and got the MRI done, which indicated a fully torn ACL, in addition to bone contusion. I was mentally ready for whatever, and it didn't really affect me too much. I had definitely done something to my knee, and I was just ready to find the right way to move forward and get on with it. I was not too comfortable with Doc 2, and so fixed up an appointment with a specialist (Doc 3) in sports injuries, as well as another well-reputed ortho (Doc 4). Doc 3 did not want me to bring in the MRI as he was of the opinion that a physical examination will reveal more. I can definitely understand this attitude as an MRI is not 100% indicative of anything, and is just one part of the diagnostic process. Doc 3's diagnosis was a torn ACL and meniscus, and for me to have surgery immediately. Doc 4 told me to rest some more, wait for the swelling and contusion to subside, and then get surgery. ### Did I rest too much?

By this time, I was worried and confused. I was not sure what the right thing to do was - rest or physiotherapy. My bones were still contused, but my knee functionality kept diminishing. I had been resting my knee, just as recommended, and it wasn't getting any better. And while I was recommended surgery, that just did not sound or feel right at all, at this point of time. Would I undo all the rest, hurt myself more if I did physiotherapy? I was not helped by a training accident a couple of weeks earlier, when my home pullup bar fell down. I had restricted my training to upper body work alone, coz it is important not to be active and not gain weight in a situation like this. Pretty straightforward, but accidents happen. While not much happened to my leg, it just made me realize how vulnerable my knee was, and how small things like tripping/slipping would be catastrophic. So, I stopped training after the accident, and just focused on what I needed to do. Against doctor's orders, I started doing some band work on my knee. And started to feel better day within a few days. I realized it was time to find a good physiotherapist, as in hindsight, it looks like I rested my knee for too long. Maybe, if I had started physiotherapy earlier, this problem could've been a bit easier to solve possibly. Too late to think about that, I had a knee to fix. [caption id="" align="aligncenter" width="366"] This is how much I could bend my knee in the early days of physiotherapy. Yes, I could not bring my heel closer to my butt.[/caption] And I couldn't sit on my heels as well, something I've always done. In fact, I've never had to contemplate not being able to do something as mundane as this. [caption id="" align="aligncenter" width="366"] Can't sit down on my heel.[/caption] ### A Confusing Process

This was definitely a very confusing process. I have not had that much exposure to injuries personally, and learning to handle an injury is one thing. Learning what to do is another. Evaluating conflicting advice, figuring out the best way to go ahead - stressful, let me tell you! Everyone has their own prejudices, their own skew. It becomes vital to figure out what is important for you, a totem if you may, and guide yourself through the process based on that. For me, I broke it down as such, 1. Uhh, this hurts. A lot. I need to see a doctor (Doc 1). Shut up and do what he says, it just hurts too much.
2. Find a doc in Madras, as it is a lot more convenient. Diagnose the problem.
3. Do my research, figure out what is negotiable, and what is not. I wanted to get back to full fitness, get back to what is "normal" which is do a bunch of stuff - play, lift weights etc. Surgery might be necessary, but is still an elective surgery. And that I should get my knee as functional as possible, before surgery.
4. Settle on a doc that I liked. This took a while, but I finally did. Listen to them, see how I respond.
5. While I did what was recommended, it didn't seem to help. After giving it an honest shot, I realized that this approach might be right for some folks but was not right for me.
6. Tried the alternate approach, realized it felt better. And found an expert on the same wavelength as me. And proceeded to listen to him.
7. Am I getting better? If so, continue doing what am doing. If not, well, that's for the second part.

I will finish up this story next week. I want to leave you with a thought, a digression. Conflicting pieces of advice is common, especially in the world of health and fitness. From where I stand, my advice and recommendations on nutrition and training are more on the "right" side of the scale than the "wrong" side. Some things I recommend seem blatantly wrong - eat egg yolks, good fats, rice over wheat etc. Even though these things are based on solid science, since it goes against what we've heard all our lives, it is hard for folks to accept. Maybe to the surgeon(s) and my physio, what I should've done was straightforward. But it was not at all, to me. I had to come up with a system for me to navigate through this process. And that's what you need to do too, to figure out similar conundrums that you face. For my part, I will redouble my efforts to be elucidate my stance further to aid you on your fitness journey. Again, this is by no means a guide for you through your ACL injury (or any injury). At the end of the day, you got to take the call. And maybe reading my account will help you figure out what framework to use to make that call.